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Current immigration policies are straining hospices ability to grow and retain their workforce amid widespread shortages.

Immigrant workers help to fill some of the biggest areas of need in the hospice and palliative care labor supply. But national policies are contributing to a diminishing pool of these workers, putting pressure on providers capacity to accept patients, according to OpusCare President and CEO Dr. Ismael Roque-Velasco.

Whats happening in our country during the last few years in immigration has really impacted the health care labor force, Roque-Velasco told Hospice News. What weve seen is that immigration policies arent helping, they are jeopardizing health care access without enough workers to provide care.

OpusCare offers hospice and palliative care in Florida, Texas and Georgia. Two of those states Florida and Texas along with California, are home to nearly half (45%) of the countrys overall immigrant population, according to Pew Research Center data.

National immigration policies are limiting the scope of hospice workforce growth in these states, as well as many others nationwide, said Roque-Velasco.

Foreign-born workers represent 38% of hospice and home health aides, a quarter of personal care aides and 28% of all highly-skilled health care professionals such as physicians and nurse practitioners, according to the National Immigration Forum.

Additionally, immigrant workers make up 22% of the nations nursing assistants and 17% of the entire health care and social services industry, reported the Migration Policy Institute.

With fewer immigrants available to take those jobs, hospices may be particularly vulnerable.

Immigration policies disproportionately impact hospice employees in comparison to other health care settings, according to Mollie Gurian, vice president of home based and home- and community-based services policy at LeadingAge.

Theres an extra step and levels to having qualified people, and immigration is a big part of that, Gurian told Hospice News. Weve heard from hospices that utilize immigration-specific programs to help with the soup to nuts process of obtaining worker visas that it can be harder to hire and train somebody whos just arrived in the country to provide the care needed at the end of life.

U.S. immigration laws are a complex web of rules. Generally, the federal government bases these on principles that include admitting workers with skills that are valuable to the U.S. economy and promote diversity, among others, according to the American Immigration Council.

Duration and eligibility requirements for visa classifications vary, but some allow employers to hire foreign-born workers on either a permanent or temporary basis.

The Immigration and Nationality Act (INA) requires annual caps for the number of working visa recipients across various business categories. The law stipulates that the president must consult with Congress each year on setting those thresholds. The annual limit for permanent employment-based immigrants is 140,000, including eligible family members.

Prospective employers can sponsor an individual for a visa, but the U.S. Department of Labor in some cases requires them to first prove a need in the labor market before even filing a petition.

Immigration processes can take considerable time and effort to complete. This, along with varying levels of eligibility requirements, can hinder hospices ability to recruit and retain this workforce, according to Ben Marcantonio, interim president and CEO, and COO of the National Hospice and Palliative Care Organization.

It can take years, even decades, to navigate your way through the system to get to the United States with a work permit, Marcantonio told Hospice News in an email. While there hasnt been significant immigration reform in decades, policies by the Trump administration, set during the COVID-19 pandemic, increased the backlog of individuals waiting to come to the United States for work. Our aging population and workforce has only exacerbated this worker shortage.

The Trump Administration tightened restrictions on immigration and stepped up deportations. Among other policies, the administration placed firmer limits on incoming workers from certain countries such as Mexico and India, among others.

All told, the White House implemented more than 470 administrative changes during Trumps presidency, an unprecedented pace compared to previous executive actions, reported the Migration Policy Institute.

The fluctuations in immigration policies are creating a self-perpetuating cycle of labor and patient access pressures, said Gurian.

Its important to have a domestic and international pipeline of workers, Gurian told Hospice News. We need all the people we can get specifically for aging services in our demographic reality and make it easier to come to the country by providing wrap-around funding and support when they get here.

Congress and the Biden Administration during the past two years have made attempts to expedite processes for bringing in immigrant workers, including some specific to health care.

In early 2021, the U.S. Citizenship Act died in committee. The bill would have raised the green card limit, eliminated per-country caps, and excluded dependents from the annual maximum on employment-related immigration.

Report language associated with the 2023 State Department appropriations bill, recently approved by the U.S. House of Representatives, urged the agency to streamline the visa process overall, as well as take action to improve processing of immigration applications from medical professionals.

Through report language, Congress makes recommendations to federal agencies on how to use their resources. However, agencies are not required to implement those recommendations.

The U.S. Department of Homeland Security 2023 appropriations bill contains similar language pertaining to the U.S. Citizenship and Immigration Services (USCIS) processing of backlogged and delayed applications. It also increased the USCIS budget by $273 million above 2022 levels, but falls below the agencys funding request by $230.0 million.

The current immigration environment is creating dangerous and detrimental situations for those who want to work in U.S health care, according to Roque-Velasco. Organized and controlled immigration is needed to help create pathways of staffing change in serious illness and end-of-life care, he added.

The only thing were doing is making a lot of criminals very rich, said Roque-Velasco. Some of these immigrants pay thousands just to get across the border and are risking their lives in some areas. If we had a way of bringing people into training and education programs with some kind of controlled immigration, to create some incentives for an immigration policy that will give legal pathways to licenses in different areas, then we might find a great solution to the problems were facing now.

In the absence of reform, hospices can take steps in their own training and education programs to include immigrant pathways to clinical, caregiving and other supportive roles, said Roque-Velasco.

For instance, they can offer sponsorship programs for hospice or home health aides to receive nursing or other clinical education in hopes of advancing their careers into those professions, he stated. The education process could begin remotely before they enter the United States, he added.

Advocates in the hospice space have said that training and education pathways need to be built into immigration policy.

If the current immigration system isnt fixed, then the nation could see more eligible patients die waiting for hospice care without enough workers to provide it, according to Marcantonio.

We need to renew a pathway specifically for those with a health background and training to come and work, said Marcantonio. The need for more health workers is more urgent.

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How Immigration Policy Impacts the Hospice Workforce - Hospice News

Immigration or Invasion?

A report published in an article by the Federation for American Immigration Reform had staggering statistics. During the first year of Bidens Administration, the illegal alien population increased by 1 million, adding $9.4 billion in cost to American taxpayers! Currently, a total of 15.5 million illegal aliens reside in the USA, and the costs of providing taxpayer funded services and benefits to these and their US-born children now is at a whopping $143.1 billion per year! Bidens policies such as terminating the construction of the border wall, cancelling of the Mexico Agreement, and the purposeful defiance of Federal Laws has accelerated this illegal invasion.

This is unfair to American Citizens and to those immigrants who came legally. It creates a humanitarian crisis where illegal aliens are being victimized by drug cartels and sex traffickers for profit. Security issues are compromised where vetting for terrorists ties has been practically impossible because of the sheer numbers invading our country!

Bidens favoritism for the illegal immigrants over American citizens have been obvious. For example, DHS made sure that ample baby formula was available to illegal immigrants and their infants, while American Moms faced empty shelves!

President Biden took an oath to protect and defend our Constitution, our Laws, and our citizens. But he has failed miserably on all counts! We are a welcoming Nation. But immigration must be controlled with common sense. Without a strong, secure and cohesive America, we cannot give security or help to anyone else.

Lucia Hunter

Regarding the Win Waste Proposal

Dear Editor,

As a former longtime City Councillor in Revere, I feel compelled to offer my thoughts on the WIN Waste proposal for a Host Community Agreement in Saugus.

First and foremost, it is important to acknowledge that this is a Saugus issue that should be decided by Saugus officials as well as the state when the time comes. In my two decades on the Revere City Council, I cant recall a situation in which an elected official from another community tried to influence a matter that was before us in Revere.

That does not mean Revere should be without a voice in this discussion. But it should be a voice supported by science and facts, not opinion and emotion.

Revere residents should be aware that the trash that is collected curbside in our city is brought to WIN Waste for disposal and, ultimately, is converted into electricity. The landfill at the WIN Waste facility is used only for the ash that is generated as part of the waste-to-energy process.

Unlike some who are vocal opponents of WIN Waste, I have taken the time to tour the plant and landfill on several occasions, in order to get a first-hand look at the operation and ask any questions or state any concerns I may have had. Through those opportunities, as well as research I have done on my own, I came to the conclusion that any fair-minded person would reach: WIN Waste operates in compliance with all permits and poses no risk to public health or the environment.

One of the first questions I asked when I went there concerned the unlined landfill that we have heard so much about. As it turns out, the landfill is surrounded by a barrier wall that provides as much or even more protection than a traditional plastic liner. That is not an opinion, but rather a conclusion reached by MassDEP in endorsing the use of that type of groundwater protection system.

The City of Revere and Town of Saugus have enjoyed a productive working relationship. I think it is fair to say we each want what is best for the other community. Perhaps we would be better served by allowing our counterparts in Saugus to determine what that is.

Anthony T. Zambuto

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Letters to the Editor - Revere Journal

(Photo by Erik McGregor/LightRocket/Getty Images.)

The past few years have made clear that most of American politicsnot just progressive politicshas become centered around identity and not governance. A recent New York Times piece by Stephanie Muravchik and Jon A. Shields documenting Rep. Liz Cheneys primary loss drives this point home, noting that Republicans are succumbing to the same impulses they associate with their liberal opponents: a shrill hostility to different viewpoints, an obsession with virtue signaling and a willingness to purge their own ranks. So too with the increasing contempt that Republicans and Democrats feel for one another. As Jonathan Rauch memorably put it in National Affairs: We are not seeing a hardening of coherent ideological difference. We are seeing a hardening of incoherent ideological difference. What if, to some significant extent, the increase in partisanship is not really about anything?

This uniquely abstract form of politics likely cannot go on forever, as the Times authors note, because any party that elevates symbolism over governing risks stirring mass revolt down the road. Results matter even in the age of identity politics. But an awful lot of damage can be done in the interim before reality comes crashing down.

Localizing more issues might help concretize our politicsto make it more about real policies than symbols, resentments, and identities. But even if our nationalized status quo doesnt budge an inch, there are reforms to be had at the federal levelparticularly in Congressthat could help make politics more about something again.

One step that could work is to transform the Senate filibuster. Calls from the left to abolish the filibuster outright have become louder and more frequent, and are the result of frustration among progressives that they cant easily push their agenda through Congress. Ending the filibuster altogether has its problems, but if done properly, reforming the filibuster could make it a tool for fostering a politics that is grounded more in issues and less in identities.

Congressional dysfunction breeds popular dysfunction. Although we dont like to admit it, our leaders (particularly those of our own party) shape our perceptions of politics. When they cant work together and do anything meaningful with those on the other side of the aisle, many of us internalize the message: The other side is hopelessly misguided or hateful, and the only path forward is to win at all costs and go it alone.

But a Senate governed by simple majorities could further heighten the stakes of national elections and enhance partisans threat perceptions and fears of one another. Scrapping the filibuster could further divide us.

Maintaining the status quo has considerable drawbacks: If normal legislation can pass the Senate only with a 60-vote supermajority and neither party is willing to compromise when its in the minority, not much gets done except in the event of a crisis or through reconciliation. Politicians make promises, nothing happens, and the people grow frustrated. Most of us sit on the sidelines, leaving only the most zealous left on the political playing field. Its a nasty, self-perpetuating cycle.

Moreover, the actual concrete stakes of politics become rather low. This incentivizes uscitizens and politicians aliketo act like the most irresponsible versions of ourselves in the political realm. Words no longer have consequences. We double down on our identities, symbolism, and vague and overblown rhetoric, raising the temperature of a politics where partisan fights arent exactly about anything concrete anymore.

So, if were concerned about division, scrapping the filibuster doesnt seem like the best idea, but neither does maintaining the status quo. Maybe there is a way out of this morass.

Perhaps clearing the filibusters de facto 60-vote hurdle to pass legislation should be just one of two ways to pass normal legislation through the Senate rather than the only way.

By revising the rules of the filibuster, a piece of legislation could pass through the Senate in either of two ways:

First, legislation could immediately pass with a 60-vote filibuster-proof supermajorityas is the case today. Plenty of legislation, particularly time-sensitive legislation with a broad basis of bipartisan support like the COVID relief bills of 2020 and 2021, already passes under this framework.

Second, if legislation cant attain the 60 votes required to invoke cloture and end debate, it should be able to go through the Senate with a bare majority (50 votes plus a vice presidential tiebreaker, or 51 votes), with a crucial caveat: It would have to pass again the next Congressbefore being sent to the presidents desk.

Under this proposal, the Senate rules would be changed so that a bill destined to fail the 60-vote cloture threshold could instead be put up for a vote to the entire Senate sitting as a committee of the whole. Thus, its passage would not trigger the presentment requirement of Article I Section 7 (if the House has already passed the bill). Then, bills that have passed the Senates committee of the whole via simple majority in the prior Congress would be taken up at the beginning of the new Congress, with a filibuster carveout in effect (i.e., these bills passed by the committee of the whole would be able to make it to a floor vote with just a simple majority). If a bill makes its way through the Senate on round two, it would have to pass through the House again since its a new Congress.

What would this look like in action?

Say the Senate was able to muster 55 votes for a comprehensive immigration reform package. Fifty-five doesnt equal 60, but instead of letting the immigration reform legislation die at the hands of the filibuster, this second option would allow the bill to stay alive within the Senate sitting as a committee of the whole. Then, it would sit in the Senatenot yet triggering the presentment requirement of Article I Section 7until the start of the next Congress. Next, for the bill to become law, the Senate would have to repass the legislation with a bare majority during that next Congress following the election cycle. The bill would then have to pass through the House again and be signed by the president.

The key value-add of this reformed filibuster would be its effect on our political discourse: It would help clarify the stakes of campaigns, thereby nudging us (and our elected leaders) to focus a bit more on the actual pending bill and the policy questions it encompasses.

Making available this second, simple majoritarian but slow-moving route to passing legislation could help make our elections revolve around tangible issuesindeed, actual legislation!once again. Senators and their challengers would campaign on whether they support X bill, which had passed through the Senate committee of the whole. That, in turn, could help turn down the temperature as we inch back toward a more concrete and less symbolic politics. We would be debatingand candidates would be forced to run onactual legislation rather than vague, often unattainable promises or fear-driven, overhyped accusations regarding the other side of the aisle. Then, the American people would have the chance to indirectly voice their opinion on the most relevant pieces of legislation, as they could choose to elect a pending bills supporters or its opponents.

Having this second option available for passing legislation in the Senate could also save us from rash legislation that could fundamentally alter American life with a bare majority because, by design, it would build in a cooling off period. The legislation would have time to percolate through the public square before gaining the force of law. Americans could have time to formulate informed opinions regarding itand frankly, so too could our politicians for a change. In fact, it might even bring more Americans into the political process. While appearing on The Remnant podcast with Jonah Goldberg, Sen. Ben Sasse once stressed how so many centrists have washed their hands of politics; they have ceded the political playing field to the politically addicted extremists. They see a politics full of fringe policy proposals and heated, bad-faith arguments, and they conclude that their time is better spent on alternative pursuits. This amended filibuster proposal stands the chance of pulling some of those centrist types back into the political fray, because it will make the stakes of politics clearer. It will make the (as of now) fairly rational calculation to sit on the political sidelines a bit less rational.

In sum, this revised filibuster rule could advance both democracy (the most legitimate, nonpartisan call to arms of the filibusters detractors) and deliberation (the most legitimate, nonpartisan rallying cry of the filibusters defenders). In addition, it might even help foster a less extremist politics.

The net result of this would be a more democratic, yes, but also a more reasonable legal regime. As founders like James Madison well understood, time and reason go hand-in-hand in day-to-day life as well as in politics. Legislation that takes longer to pass is more likely to be the product of reason than passion. At the same time, Madison was a majoritarian through and through; the minority ought not be empowered to indefinitely block the majoritys (constitutional) will.

By championing this additional option as an alternative to the standard filibuster-proof supermajoritarian path of passing legislation through the Senate, our senators can advance democratic values and lay the groundwork for a more reasonable, less vitriolic, less divisive, and more concrete politics.

This might help bring a much-needed dose of reality back to American politicsbefore its too late.

Thomas Koenig is a student at Harvard Law School, and the author of the Toms Takes newsletter. Follow him on Twitter @thomaskoenig98.

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ReformingNot Abolishingthe Filibuster Could Improve Our Politics - The Dispatch

Women are threatening to stop having sex with men until abortion rights are restored across America. Will women bring men to their knees and save Roe v Wade?

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@Thom_Hartmann Abortion Bans Abortion Rights America Roe V. Wade The Thom Hartmann Program Women

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Will Women Stop Having Sex To Protest Abortion Bans? - Free Speech TV

On August 18, NPRs Morning Edition ran the results of a poll the outlet conducted with research outfit Ipsos on respondents perceptions of immigration. More than half (53 percent) believe it is either wholly or partially true that there is an invasion occurring at the Southwest border, while support for immigration is falling and a border wall is becoming more popular. That poll also reveals the toll Bidens Border Fiasco is inflicting on Americans support for immigration.

Invasion. That poll was conducted between July 28 and 29, surveying 1,116 U.S. adults. As Ipsos described its findings, most Americans are buying into the idea of invasion at the southern border, itself a form of spin. When was the last time that you heard a polling outfit talk about how many citizens are buying into the idea of a second Biden presidency, for example?

That said, 28 percent of respondents believe that its completely true that an invasion is occurring at the border, including 51 percent of Republicans, 24 percent of independents, and 12 percent of Democrats.

An additional 25 percent of respondents opined that it was somewhat true that there is an invasion at the U.S.-Mexico line. Most troubling for the administration, that includes 29 percent of Democrats, as well as 25 percent of Republicans and 23 percent of independents.

Nineteen percent of respondents dismissed the idea of an invasion as completely false, with Democrats leading the way at 34 percent, independents next at 18 percent, and Republicans at 8 percent. Twenty-seven percent dont know: 36 percent of independents, 25 percent of Democrats, and 16 percent of Republicans.

The midterm congressional elections are less than 90 days away, so this spells trouble for the president and his fellow partisans, and an opportunity for the GOP (if they were willing to seize it).

Immigration is an issue that stirs Republicans to vote, but it will be the undecided independents who will move the needle in tight races, and they are more than twice as likely to view the chaos at the Southwest border as an invasion than not.

Worse, however, Democrats are overall more likely to entertain the idea of a border invasion than to dismiss it out of hand, by a 41 percent to 34 percent margin. That likely doesnt matter much to progressives or casual Democrats in Vermont or Minnesota, but there is a major Senate race in Arizona and incumbent Sen. Mark Kelly (D-Ariz.) likely doesnt want to be tied to such impressions about his states border with Mexico.

Declining Support for Immigration. That poll also reveals declining support among Americans for immigration. While 56 percent of respondents agreed that immigrants are an important part of our American identity, thats down from May 2021, when 62 percent took that position, and way down from February 2018, when 75 percent agreed.

Similarly, just over half (51 percent) believed that Dreamers aliens brought to the United States as children and here illegally should be given legal status. Thats a drop from 59 percent in July 2020, and from 65 percent in February 2018. That said, it has been static since May 2021, when again 51 percent were in favor of amnesty for Dreamers.

Support for a wall or fence along the Southwest border is also growing, with 46 percent in the latest Ipsos poll in favor of such barriers, up slightly from 45 percent in May 2021, but a big jump from the 38 percent who agreed in February 2018.

Barbara Jordan Vindicated, Again. NPR cant figure out why Americans responded in this manner, naively stating: It's not clear why those numbers have shifted. For her part, Ipsos Mallory Newall suspects the explanation is tied to broader concerns about inflation and the economy, while the outlet itself notes: There's also a theory that support for immigrants tends to fall when there is a perception of chaos at the southern border.

Gravity is technically a theory, but dont test it out by jumping from an airplane without a parachute. And, with due respect to Newall, if broader concerns about inflation and the economy were driving these numbers, why would support for immigrants be lower now than during the depths of Covid-19 in the summer of 2020?

As I noted recently in my analysis of similar polling numbers, civil-rights icon Barbara Jordan and then-chairwoman of the federal Commission on Immigration Reform warned in 1994 that popular support for immigration would so decline if the government couldnt keep illegal immigration in check:

If we cannot control illegal immigration, we cannot sustain our national interest in legal immigration. Those who come here illegally, and those who hire them, will destroy the credibility of our immigration policies and their implementation. In the course of that, I fear, they will destroy our commitment to immigration itself.

Illegal immigration has never been less controlled than it is right now. In fact, with two months to go in the fiscal year, Border Patrol has already apprehended more illegal migrants at the Southwest border in FY 2022 than in any previous year, already breaking the dubious apprehension record set by Biden in FY 2021.

Why cant NPR just admit these facts? Remember in March 2021 when the Washington Post contended The migrant surge at the U.S. southern border is actually a predictable pattern? Those were the findings of experts, and thus likely more than a theory, according to Morning Edition. Or when Biden himself proclaimed that month:

The truth of the matter is, nothing has changed. As many people came 28 percent increase in children to the border in my administration. Thirty-one percent in 2019 before the pandemic in the Trump administration ... It happens every single solitary year. There is a significant increase in the number of people coming to the border in the winter months of January, February, March it happens every year.

Both of those assertions were demonstrably wrong, but both the experts and the president advanced them. Logic should not take a holiday simply because the left-leaning (and taxpayer-supported) NPR doesnt like the logical results.

Nor does it serve the public that, again, helps fund its operations, or the immigrants themselves. As Jordan herself stated, we disagree ... with those who label our efforts to control illegal immigration as somehow inherently anti-immigrant. Unlawful immigration is unacceptable.

Immigration is good but controlling immigration is essential (and not anti-immigrant), too, if for no other reason than to guarantee that support stays strong by ensuring that immigration is in the national interest. As these numbers suggest, the American people question whether that is still true.

Invasion or Invitation? All of that said, a majority of Americans likely believe theres an invasion at the Southwest border in part because, as noted, the number of illegal entrants is massive by any historical standard, but also because the Biden administration which once promised to bring transparency and truth back to government is hiding its own role in this debacle.

In just 18 months under Biden, Border Patrol agents at the Southwest border have apprehended close to as many illegal entrants as during the full 96 months of the Obama-Biden administration. If current trends continue (and there is no reason to assume they wont), Bidens border total will beat his old boss by the middle of September.

That leaves Americans to wonder why this is happening now. Opinion polls show low support for Bidens handling of the border, suggesting that they blame him for not doing more there, but I doubt they realize that the administration is spurring this humanitarian disaster.

How? Shortly after taking office, Biden ditched nearly all of the successful policies his predecessor implemented to bring the border under control.

That includes the Migrant Protection Protocols (MPP), better known as Remain in Mexico. Trump implemented MPP in 2019 in response to a then-border emergency at the Southwest border, and it was an effective response.

DHS determined in its October 2019 assessment of the program that MPP was an indispensable tool in addressing the ongoing crisis at the southern border and restoring integrity to the immigration system, particularly as related to alien families.

Indispensable is defined as absolutely necessary and not subject to being set aside or neglected, but Biden has not only eagerly cast the program aside, his DHS secretary has twice tried to kill it, and his administration has fought state efforts successfully to this point to terminate it.

The same is true of CDC orders directing the expulsion of illegal entrants at the border, issued under Title 42 of the U.S. Code in response to the Covid-19 pandemic. Even though DHS warns that up to 18,000 migrants will enter the United States daily once Title 42 ends, Biden is fighting a federal district court injunction that requires the administration to keep the CDC orders going.

Why would Biden want to end an indispensable MPP, and terminate Title 42 even if that means that the number of illegal entrants will more than double from already historic highs?

Because, as his DHS secretary explained in May, the Biden administrations objective is not reducing the total number of illegal immigrants coming across the southern border.

Rather, the objective of the Biden administration is to make sure that we have safe, orderly, and legal pathways for individuals to be able to access our legal system, that is, to ensure that every migrant who makes it here can apply for asylum, regardless of the strength of their claim or how long it takes to hear it.

The resulting surge is not an invasion its an invitation to enter illegally that tens of thousands of foreign nationals are accepting every month. The administration is not ineffective in its border efforts; to the contrary, the results at the U.S.-Mexico line speak for themselves.

That said, the people working in the West Wing are smarter and more compassionate than the folks whom they purportedly serve (or at least think they are), so they cant just come out and tell the less-enlightened what they are doing as openly as the secretary did in May.

The problem, as this poll reveals, is that in its efforts to throw the nations Southwest border open to all comers, the Biden administration is helping to stir a backlash that could, and probably will, adversely affect millions of would-be legal immigrants for years to come. Enforcement is not anti-immigrant, but sometimes ironically non-enforcement is.

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NPR/Ipsos Poll: Majority of Americans Believe There's an 'Invasion' at the Southwest Border - Immigration Blog